Individual
MR. THOMAS DAVID MOLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MS,
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03649
OR
225100000X
Physical Therapist
PT00007650
WA
2251X0800X
Orthopedic Physical Therapist
3649
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
322858
PROVIDENCE HEALTH PLAN
OR
01
—
J5366-01
PACIFICSOURCE HEALTH PLAN
OR
Enumeration date
11/15/2006
Last updated
03/25/2016
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